ABSTRACT
Psoriasis is a chronic inflammatory skin disease that is characterized by well-demarcated erythematous plaques with a silver scale. Although many new and emerging therapeutic agents are often sufficient to control the disease, there is still a need for alternative treatment options in challenging cases. Extracorporeal photopheresis (ECP) has been applied to many T-cell-mediated diseases to restore immune homeostasis and treat psoriasis effectively. In this paper, we present a psoriasis patient who did not respond to methotrexate, narrowband ultraviolet B, or acitretin. Because of a diagnosis of non-Hodgkin lymphoma, the patient had contraindications for cyclosporine, fumaric acid esters, and biologics but achieved remission with a total of 12 sessions of ECP in two and a half months. Although exacerbation was recorded after polymerase chain reaction (PCR) confirmed coronavirus 2019 (COVID-19) disease infection at the end of the first month, scores from the psoriasis area severity index (PASI) and dermatological life quality index (DLQI) were regressed significantly within two and a half months. ECP seems to provide an effective and rapid response for psoriasis and should be considered for psoriasis patients who fail to respond or have contraindications to existing treatments.
Subject(s)
COVID-19/complications , Lymphoma, Non-Hodgkin/complications , Pandemics , Photopheresis , Psoriasis/drug therapy , SARS-CoV-2 , Acitretin/therapeutic use , Chemical and Drug Induced Liver Injury/etiology , Combined Modality Therapy , Contraindications, Drug , Cyclosporine/adverse effects , Humans , Male , Methotrexate/adverse effects , Methotrexate/therapeutic use , Middle Aged , Nails/pathology , Psoriasis/complications , Psoriasis/pathology , Psoriasis/radiotherapy , Quality of Life , Severity of Illness Index , Ultraviolet TherapyABSTRACT
Aims: There is currently no evidence-based guideline to show how to manage immunosuppressive treatment in patients with hidradenitis suppurativa (HS) during the Coronavirus disease-2019 (COVID-19) pandemic. Therefore, we updated our routine clinical protocol to 1) inform patients with ongoing treatment about the potential risks of their medications in the case of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection, 2) discuss opt out of treatment temporarily, and 3) perform a closer follow-up on a monthly basis. The aim of this study was to evaluate the clinical outcomes in patients with HS, who suspended and continued immunosuppressive therapy following COVID-19 outbreak. Methods: This retrospective study included patients with HS, who had been receiving biologic/immunosuppressive treatment when the COVID-19 pandemic was announced. Those who withdrew treatment for any reason or continued were analyzed. The primary endpoint was physician-diagnosed disease exacerbation. The secondary outcomes were changes in visual analogue scale (VAS) and COVID-19 diagnosis. Results: A total of 37 patients were included in the analysis. The majority of the patients were on adalimumab treatment (n=33). Fifteen (40.5%) patients withdrew the treatment for COVID-19 related concerns. During 83.2±0.6 days of follow-up following the withdrawal, all patients in this group had at least one exacerbation. Also, the mean VAS score increased from 5.7±0.56 to 8.6±0.57 (p=0.001). On the other hand, three patients (13.6%) who continued the treatment reported worsening in disease course, 12 patients (54.5%) remained stable and seven of them (31.9%) had clinical relief. We did not observe any confirmed SARS-CoV-2 infection in any of our 37 HS patients. Conclusions: The present study suggests that even a temporary withdrawal of biologic/immunosuppressive treatments may have significant adverse consequences on disease course and quality of life in patients with HS. These individuals may safely continue the treatment provided that maximum measures are taken to avoid COVID-19 infection.
ABSTRACT
INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory skin disease of hair follicles which usually affects patients' quality of life negatively. Although there are various therapeutic approaches including topical and systemic antibiotics, retinoids, biological agents, and also surgical modalities, there is no curative treatment option and clinical management of HS is still challenging. CASE PRESENTATION: Herein, we present a 43 year-old man with HS who had used different treatments in 15 years. The patient showed improvement initially with adalimumab, then exhibited secondary unresponsiveness after 18 months. While worsening of HS was recorded due to increased discharge under secukinumab, no additional benefit was observed with methotrexate. He was not willing to undergo surgical procedures due to previous surgical experience. Finally, certolizumab pegol has been started to patient with similar dosing to psoriasis patients. Sartorius, 10-point visual analogue scale (VAS), and dermatological life quality index (DLQI) scores regressed from 171 to 105, 9/10 to 3/10, and 27 to 19 after 3 months with certolizumab pegol treatment. DISCUSSION/CONCLUSION: Certolizumab pegol is a humanized antigen-binding fragment of a monoclonal antibody which binds to TNF-alpha. However, certolizumab pegol is only approved for plaque psoriasis in dermatology; it is likely to be a promising effective agent for HS, especially in challenging cases.